Individual
DR. RUDY JEROME VERVAEKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
21420 HARPER AVE, SUITE 2, SAINT CLAIR SHORES, MI 48080-3607
(586) 775-7400
(586) 775-0091
Mailing address
21420 HARPER AVE, SUITE 2, SAINT CLAIR SHORES, MI 48080-3607
(586) 775-7400
(586) 775-0091
Taxonomy
Speciality
Code
Description
License number
State
207RA0401X
Addiction Medicine (Internal Medicine) Physician
Primary
4301044898
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1105018171
BLUE CROSS BLUE SHIELD
MA
01
—
352263519
COMMERCIAL
MI
05
—
4842512-10
—
MI
Enumeration date
09/22/2006
Last updated
11/20/2015
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